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Hashemi H, Babaee T, Moradi V, Bagheri M, Moghadam MJ, Ashkar M, Tavakoli B, Gordahani AA, Habibi Z. Cranial remolding orthosis for children with deformational skull deformities: A systematic review on the factors affecting success and duration of treatment. World Neurosurg X 2024; 23:100386. [PMID: 38799788 PMCID: PMC11127277 DOI: 10.1016/j.wnsx.2024.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Deformational plagiocephaly, deformational brachycephaly, and deformational scaphocephaly are the most common types of skull deformities during the first year of life. Using a cranial remolding orthosis (CRO) can have an important role in achieving a satisfactory level of improvement in symmetry and proportion of the deformed skulls. However, there is no consensus on the most important parameters for the success or length of treatment with a CRO. In this study, we did a systematic literature review in PubMed, Scopus, Web of Science, and EMBASE on January 2023. Titles/abstracts of the found studies were screened by two independent reviewers. The Newcastle-Ottawa Scale was used to evaluate the quality of the included articles. The best evidence synthesis was considered to determine the strength of the reported factors. A total of 25 articles with an accumulated sample of 7594 participants were included. Nine predictive factors, including age at initiation of CRO treatment, CRO compliance, deformity severity, deformity type, torticollis, gestational age, gestational type, delivery method, and developmental delay, were considered for CRO treatment length or success. Moderate evidence suggests that CRO treatment length is linked to a patient's age at the start of treatment and the deformity severity. Moreover, treatment success is correlated with a patient's age at the start of treatment, CRO compliance, and deformity severity. Moderate evidence indicates that there is no relationship between the presence of torticollis and gestational age with CRO treatment success.
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Affiliation(s)
- Hoda Hashemi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
| | - Mahtab Bagheri
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Moghadam
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ashkar
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behnaz Tavakoli
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Gordahani
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Hauc SC, Junn AH, Long AS, Rivera JC, Littlefield TR, Ihnat JM, Shah HP, Pondugula N, Almeida MN, Alper DP, Persing JA, Alperovich M. Orthotic Helmet Therapy for Deformational Plagiocephaly: Stratifying Outcomes by Insurance. Cleft Palate Craniofac J 2024; 61:1027-1032. [PMID: 36655295 DOI: 10.1177/10556656231152517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status. DESIGN This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014-2020 across 21 states. PATIENTS, PARTICIPANTS There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy. MAIN OUTCOMES MEASURES Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success. RESULTS Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51-1.65, p < 0.001 and OR: 1.21, CI: 1.15-1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70-3.92, p < 0.001). CONCLUSIONS Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here.
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Affiliation(s)
- Sacha C Hauc
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam H Junn
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Aaron S Long
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jean Carlo Rivera
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Jacqueline M Ihnat
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Hemali P Shah
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Nishita Pondugula
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mariana N Almeida
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David P Alper
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - John A Persing
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
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Sertorio F, Pacetti M, Schiaffino S, Secci F, Cama A, Consales A, Magnano GM. Ultrasonography as first line imaging for the diagnosis of positional plagiocephaly. Minerva Pediatr (Torino) 2023; 75:557-560. [PMID: 30916518 DOI: 10.23736/s2724-5276.19.05424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In the last years, numerous studies evaluated different tools for the diagnosis of positional plagiocephaly (PP). The purpose of this study was to evaluate ultrasonography (US) as a first line screening test of lambdoid sutural patency in child with PP and to compare our results with the literature. METHODS All consecutive patients who referred to our Institute from January 2016 to October 2017 with the suspicion of PP, were included in the study and performed US examination of the lambdoid sutures. A 3-6-month clinical follow-up was performed by a pediatric neurosurgeon or a pediatrician to confirm the diagnosis of PP. RESULTS Thirty-five children performed US examination and in all cases the diagnosis of PP was confirmed. No cases of anticipated suture fusion were examined during this period. The concordance between US findings and clinical exam follow-up was 100%. CONCLUSIONS Ultrasonography of the lambdoid sutures represents an ideal first-line screening test and reliable alternative to other diagnostic techniques for lambdoid sutural patency in child with PP, being radiation free, fast and cheap.
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Affiliation(s)
- Fiammetta Sertorio
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy -
- Department of Radiology, University of Genoa, Genoa, Italy -
| | - Mattia Pacetti
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Francesca Secci
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Armando Cama
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Gian M Magnano
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Miyabayashi H, Saito K, Kato R, Noto T, Nagano N, Morioka I. Denominator of Cranial Vault Asymmetry Index: Choosing Between Longer and Shorter Diagonal Lengths. J Craniofac Surg 2023; 34:e369-e372. [PMID: 36922383 PMCID: PMC10205121 DOI: 10.1097/scs.0000000000009263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 03/17/2023] Open
Abstract
Since it was proposed in this journal in 2001, the cranial vault asymmetry index (CVAI) has been an important parameter for assessing cranial shape. However, different publications currently use different variables in the denominator of the CVAI formula. We thus investigated the use of long and short diagonal lengths as variables in the denominator of the CVAI formula. We searched the databases of PubMed, Google Scholar, and Scopus for articles published between 2016 and 2022 that cited the original work article of CVAI. Articles were included if they were written in English and if the denominator of the CVAI formula was specified. For multiple articles by the same author, only the most recent article was included. In total, 30 articles were included; 10 articles used the longer diagonal length as the denominator and 20 articles used the shorter diagonal length. No uniform trend was observed by a country or journal of publication. Application of the CVAI formula using different denominators yielded interchangeable results, and the resulting values had only negligible differences clinically. However, it would be necessary to create a standard formula for using the CVAI as a parameter for reporting cranial shape assessments consistently.
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Affiliation(s)
- Hiroshi Miyabayashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
- Department of Pediatrics, Kasukabe Medical Center, Saitama, Japan
| | - Katsuya Saito
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
- Department of Pediatrics, Kasukabe Medical Center, Saitama, Japan
| | - Risa Kato
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Takanori Noto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo
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Predictive Factors of Outcomes in Helmet Therapy for Deformational Plagiocephaly and Brachycephaly. J Craniofac Surg 2023; 34:231-234. [PMID: 36210494 DOI: 10.1097/scs.0000000000009048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023] Open
Abstract
Deformational plagiocephaly and brachycephaly, or abnormal flattening of the infant skull due to external forces, are often managed with orthotic helmet therapy. Although helmet therapy is widely used, the factors that predict poor outcomes are not well characterized. In this study of over 140,000 patients who received helmet therapy, older age and greater severity at presentation, and noncompliance with treatment were each independently associated with worse craniometric and provider-reported outcomes. Each additional point of cranial vault asymmetry index or cephalic index at a presentation is associated with an increased likelihood of residual brachycephaly at completion [odds ratio (OR): 1.067; 95% Cl: 1.058-1.075; P <0.0001 and OR: 2.043; 95% CI: 2.021-2.065; P <0.0001, respectively], whereas each additional point of cranial vault asymmetry index at a presentation associated with increased likelihood of residual asymmetry at completion (OR: 2.148; 95% Cl: 2.118-2.179; P <0.0001). Patients were more likely to have residual brachycephaly or asymmetry with increasing age at treatment initiation (OR: 1.562; 95% CI: 1.524-1.600; P <0.0001 and OR: 1.673; 95% Cl: 1.634-1.713; P <0.0001, respectively, for each additional month of age at initiation). These results highlight a need for prompt referral for helmeting, especially in cases with severe features or when patients present late to care. Potentially modifiable factors are age at helmeting and compliance with treatment protocols, and consideration of these factors may be important for achieving success in some cases.
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Development and Validation of a Prediction Model for the Treatment Time of Deformational Head Shapes Using a Cranial Remolding Orthosis. CHILDREN 2022; 9:children9030354. [PMID: 35327726 PMCID: PMC8947519 DOI: 10.3390/children9030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
The cranial remolding orthosis (CRO) has been shown in previous studies to be an effective method of treatment for deformational head shapes. Many studies have shown younger infants achieve greater correction than older infants and generally have a shorter treatment duration. The goal of this study is to develop and validate a prediction equation for the maximum treatment time for deformational head shapes when utilizing a CRO. This retrospective study included subjects with deformational plagiocephaly (DP), deformational brachycephaly (DB), or deformational asymmetrical brachycephaly (DAB) who began CRO treatment between 3 and 18 months of gestational age. Prediction models were derived from 1250 subjects with DP, DB, and DAB and the validation used data from 210 different subjects. Actual treatment time was less than or equal to predicted treatment time in 85.19% (DP), 56.67% (DB), and 75.40% (DAB) of the cases when rounding the prediction up to the nearest month. The prediction equation has moderate accuracy for predicting the likely maximum amount of CRO treatment time for patients with DP, DB, and DAB and may be used clinically to give caregivers an estimated treatment duration for a patient who is indicated for a CRO, if treatment was initiated immediately.
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Long-Term Results After Head Orthosis Therapy for Early Childhood Position-Related Cranial Deformities: Stability of Treatment Outcome and Parental Satisfaction. J Craniofac Surg 2021; 33:97-100. [PMID: 34677038 DOI: 10.1097/scs.0000000000008009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The purpose of this study was to determine whether different types of position-related cranial deformities show changes after completion of head orthosis therapy. We investigated how children's age at the begin of molding helmet therapy affects the duration and long-term stability of treatment. In addition, parental satisfaction with helmet therapy has been investigated. Between 2012 and 2019, 47 patients have been analyzed after undergoing helmet therapy. At the beginning of treatment different disease pattern were classified. Posterior deformational Plagiocephalus defined by a cranial vault index (CVA) > 1 cm and a cranial index (CI) <= 90%. Posterior deformational Brachycephalus defined by CVA <= 1 cm and CI > 90%. Posterior deformational combined Plagio- and Brachycephalus defined by CVA > 1 cm and CI > 90%. At the beginning of therapy, the end of therapy and within 5-year-follow-up CI and CVA was measured by three-dimensional photogrammetry for 2 age groups (4-6 and 7-12 months). Additionally, parents completed a standardized questionnaire to evaluate the personal assessment of treatment outcome. During treatment CI and CVA of all children decreased significantly (P < 0.001). Furthermore, CI significantly decreased after ending helmet therapy (P < 0.001). Cranial vault index decreased not significantly in the same period (P = 0.361). For the 4 to 6 months old group treatment time was significantly shorter than for the older group. Before starting helmet therapy nearly half of the parents graded the scull as moderate and one-third as severe deformed. After ending treatment, the majority of parents report satisfaction and compliance. However, one-third of parents noted a slight scull deformation and personal load during therapy. After completion of therapy an improvement of head shape can be expected for the majority of children. This is particularly evident for improvement of the CI and a shorter treatment time until the age of 6 months at the beginning of therapy. Parents reported satisfaction and child compliance. Almost all parents were convinced that treatment was useful and would repeat it again.
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Abdel Alim T, Iping R, Wolvius EB, Mathijssen IMJ, Dirven CMF, Niessen WJ, van Veelen MLC, Roshchupkin GV. Three-Dimensional Stereophotogrammetry in the Evaluation of Craniosynostosis: Current and Potential Use Cases. J Craniofac Surg 2021; 32:956-963. [PMID: 33405445 DOI: 10.1097/scs.0000000000007379] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Three-dimensional (3D) stereophotogrammetry is a novel imaging technique that has gained popularity in the medical field as a reliable, non-invasive, and radiation-free imaging modality. It uses optical sensors to acquire multiple 2D images from different angles which are reconstructed into a 3D digital model of the subject's surface. The technique proved to be especially useful in craniofacial applications, where it serves as a tool to overcome the limitations imposed by conventional imaging modalities and subjective evaluation methods. The capability to acquire high-dimensional data in a quick and safe manner and archive them for retrospective longitudinal analyses, provides the field with a methodology to increase the understanding of the morphological development of the cranium, its growth patterns and the effect of different treatments over time.This review describes the role of 3D stereophotogrammetry in the evaluation of craniosynostosis, including reliability studies, current and potential clinical use cases, and practical challenges. Finally, developments within the research field are analyzed by means of bibliometric networks, depicting prominent research topics, authors, and institutions, to stimulate new ideas and collaborations in the field of craniofacial 3D stereophotogrammetry.We anticipate that utilization of this modality's full potential requires a global effort in terms of collaborations, data sharing, standardization, and harmonization. Such developments can facilitate larger studies and novel deep learning methods that can aid in reaching an objective consensus regarding the most effective treatments for patients with craniosynostosis and other craniofacial anomalies, and to increase our understanding of these complex dysmorphologies and associated phenotypes.
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Affiliation(s)
- Tareq Abdel Alim
- Department of Neurosurgery Department of Radiology and Nuclear Medicine Research Intelligence and Strategy Unit Department of Oral- and Maxillofacial Surgery Department of Plastic, Reconstructive Surgery, and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam Faculty of Applied Sciences, Delft University of Technology, Delft Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Kim MJ, Kang MK, Deslivia MF, Kim YO, Choi JW. Applicative Factors of Helmet Molding Therapy in Late-diagnosed Positional Plagiocephaly. J Korean Med Sci 2020; 35:e295. [PMID: 32924339 PMCID: PMC7490201 DOI: 10.3346/jkms.2020.35.e295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although the benefits of helmet therapy for positional plagiocephaly are strongly correlated with age, the effective period remains controversial. However, most physicians agree that effective results can be obtained in patients within the age of 6 months. Owing to the characteristics of positional plagiocephaly in Koreans, many Korean patients have delayed diagnosis, and because this results in delayed onset of the helmet therapy, the outcomes remain largely underevaluated. In the management of late-diagnosed positional plagiocephaly, we aimed to determine the factors affecting the effective application of helmet therapy. METHODS We recruited 39 consecutive patients with positional plagiocephaly who received helmet therapy and completed the treatment between December 2008 and June 2016. The ages at initiation and completion of treatment, duration of daily use, initial and final absolute diagonal differences, cephalic index, and cranial vault asymmetry index (CVAI) were analysed using data retrospectively collected from the patients' medical records. RESULTS We identified 12 patients with late-diagnosed positional plagiocephaly, of whom 83.33% were effectively treated. The effective change in CVAI (%) was affected by age at treatment initiation (P = 0.001), initial absolute diagonal distance differences (P < 0.001), and initial CVAI (P < 0.001). Up to 9 months, a gradual change of at least 1% CVAI was attained. Treatment initiation at ages < 5.5 months was beneficial. Even at a later age, patients with an initial absolute diagonal distance difference of > 13.50 mm and initial CVAI of > 11.03% could receive effective helmet therapy. CONCLUSION The efficacy of helmet therapy in late-diagnosed patients can be predicted on the basis of not only age at treatment initiation, but also initial absolute diagonal distance differences and initial CVAI. We anticipate that even patients with late-diagnosed positional plagiocephaly can expect better helmet therapy outcomes.
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Affiliation(s)
- Min Ji Kim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Min Kyu Kang
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, Uiversity of Ulsan College of Medicine, Seoul, Korea
| | - Maria Florencia Deslivia
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, Uiversity of Ulsan College of Medicine, Seoul, Korea
| | - Yong Oock Kim
- Department of Plastic and Reconstructive Surgery, Yonsei Medical Center, University of Yonsei College of Medicine, Seoul, Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, Uiversity of Ulsan College of Medicine, Seoul, Korea.
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Kunz F, Hirth M, Schweitzer T, Linz C, Goetz B, Stellzig-Eisenhauer A, Borchert K, Böhm H. Subjective perception of craniofacial growth asymmetries in patients with deformational plagiocephaly. Clin Oral Investig 2020; 25:525-537. [PMID: 32607831 PMCID: PMC7819928 DOI: 10.1007/s00784-020-03417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
Objectives The present investigation aimed to evaluate the subjective perception of deformational cranial asymmetries by different observer groups and to compare these subjective perceptions with objective parameters. Materials and methods The 3D datasets of ten infants with different severities of deformational plagiocephaly (DP) were presented to 203 observers, who had been subdivided into five different groups (specialists, pediatricians, medical doctors (not pediatricians), parents of infants with DP, and laypersons). The observers rated their subjective perception of the infants’ cranial asymmetries using a 4-point Likert-type scale. The ratings from the observer groups were compared with one another using a multilevel modelling linear regression analysis and were correlated with four commonly used parameters to objectively quantify the cranial asymmetries. Results No significant differences were found between the ratings of the specialists and those of the parents of infants with DP, but both groups provided significantly more asymmetric ratings than did pediatricians, medical doctors, or laypersons. Moreover, the subjective perception of cranial asymmetries correlated significantly with commonly used parameters for objectively quantifying cranial asymmetries. Conclusions Our results demonstrate that different observer groups perceive the severity of cranial asymmetries differently. Pediatricians’ more moderate perception of cranial asymmetries may reduce the likelihood of parents to seek therapeutic interventions for their infants. Moreover, we identified some objective symmetry-related parameters that correlated strongly with the observers’ subjective perceptions. Clinical relevance Knowledge about these findings is important for clinicians when educating parents of infants with DP about the deformity.
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Affiliation(s)
- Felix Kunz
- Department of Orthodontics, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany.
| | - Matthias Hirth
- User-centric Analysis of Multimedia Data Group of TU Ilmenau, Ilmenau, Germany
| | - Tilmann Schweitzer
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard Goetz
- Department of Orthodontics, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany
| | | | - Kathrin Borchert
- Communication Networks of the University of Würzburg, Würzburg, Germany
| | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Würzburg, Germany
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Visse HS, Meyer U, Runte C, Maas H, Dirksen D. Assessment of facial and cranial symmetry in infants with deformational plagiocephaly undergoing molding helmet therapy. J Craniomaxillofac Surg 2020; 48:548-554. [DOI: 10.1016/j.jcms.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
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Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly. J Clin Med 2020; 9:jcm9041027. [PMID: 32260587 PMCID: PMC7231243 DOI: 10.3390/jcm9041027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
This retrospective chart review focuses on determining the most effective time to begin cranial remolding orthosis (CRO) treatment for infants with asymmetrical brachycephaly. Subjects with asymmetrical brachycephaly started CRO treatment between 3 and 18 months of age. These infants had a cranial vault asymmetry index (CVAI) ≥ 3.5 and a cranial index (CI) ≥ 90. Subjects were excluded if they had any comorbidities affecting growth, dropped out of treatment, were lost to follow-up, or were noncompliant. Factors which were found to statistically influence treatment outcomes were subject initial age, initial CVAI, and initial CI. Overall, younger subjects were more likely to achieve a corrected head shape. The presence of prematurity or torticollis had statistically nonsignificant effects on the success of treatment. Initial CI was found to be a stronger predictor than initial CVAI as to which subjects achieved correction. The less severe the starting CI, the more likely the subject was to achieve full correction. The clinical understanding is that it requires more cranial growth to “round out” a full posterior skull flattening than an asymmetry. Based on the study results, infants with asymmetrical brachycephaly should be treated as early as possible to increase chances of achieving full correction of the deformity.
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Craniofacial growth in infants with deformational plagiocephaly: does prematurity affect the duration of head orthosis therapy and the extent of the reduction in asymmetry during treatment? Clin Oral Investig 2019; 24:2991-2999. [DOI: 10.1007/s00784-019-03159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
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Abstract
Non-synostotic plagiocephaly consists in an asymmetry of the skull due to mechanical forces applied in utero or postnatally: main differential diagnosis is with true synostotic asymmetry, which is caused by the premature closure of a suture. The correction of positional forms is mostly conservative, with 3 main strategies: counterpositioning, physiotherapy and helmet therapy. There is no synthesized evidence on which is the most effective. The Authors evaluate the modification of antropometric measurments before and after a pediatric physical therapy program in a sample of patients with non-synostotic skull asymmetry, in order to evaluate the improvements in the skull shape. The hypothesis being tested was that physical therapy alone could improve the antropometric measurments. The authors enrolled in this study 24 patients diagnosed of non-synostotic asymmetry, clinically and with ultrasound, referred to the Maxillo-facial Unit of Policlinico Umberto I, Rome, within 2013 and 2016. A standardized pediatric physical therapy intervention program was designed: it consisted in a combination of excercises and manipulative procedures to reduce positional preference, musculoskeletal disorders and cranial deformity. Infants received 16 sessions of physical therapy, of 40 minutes each, once a week, for four months. The Authors evaluate the variation of four anthropometric measurments, performed before and after the physical therapy program: Argenta scale, Oblique Diameter Difference Index (ODDI), Cranial Proportional Index (CPI) or Cephalic Ratio (CR), Cranial Vault Asymmetry Index (CVAI). Craniometric evaluations were extrapolated by standardized 2D digital photographs of frontal, sagittal and transverse planes, by the same physician to minimize bias. The management of positional cranial deformities is still controversially discussed and especially the effects of physiotherapy and osteopathy have been only marginally researched. Statistical analysis revealed the effectiveness of the protocol: all anthropometric measurements improved with a high rate, major in youngest children (P < 0.5) and in more severe first presentations (P < 0.05 or P < 0.01). The results suggest manipulative approach may improve the outcome in the long term follow up of cranial asymmetries.
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Graham T, Adams-Huet B, Gilbert N, Witthoff K, Gregory T, Walsh M. Effects of Initial Age and Severity on Cranial Remolding Orthotic Treatment for Infants with Deformational Plagiocephaly. J Clin Med 2019; 8:jcm8081097. [PMID: 31344968 PMCID: PMC6723372 DOI: 10.3390/jcm8081097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to review the effects of an infant's presenting age and severity of deformation on cranial remolding orthotic (CRO) treatment outcomes for patients with deformational plagiocephaly. This study is a retrospective chart review of 499 infants with non-synostotic plagiocephaly who completed CRO treatment. Data collected included age at start of treatment, head shape measurements before and after treatment, total months of CRO treatment, and other factors such as presence/absence of prematurity. The infants were divided into subgroups according to age and severity at initiation of treatment and data for subgroups was analyzed to track the change in head shape over the course of treatment, review overall treatment duration, and discuss the rate of change of cranial deformation. Overall, treatment times tended to statistically increase with increasing initial severity and age. Posttreatment asymmetry measurements statistically trended to greater residual deformation in infants who began treatment in the older or more severe subcategories. This indicates that younger and less severe infants have shorter treatment durations and less residual cranial deformation after CRO treatment. Therefore, clinical consideration may need to be taken to treat infants at younger ages or prior to progression of the cranial deformity.
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Affiliation(s)
- Tiffany Graham
- Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center, 6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA.
| | - Beverley Adams-Huet
- Population and Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8822, USA
| | - Nicole Gilbert
- Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center, 6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA
| | - Kirsten Witthoff
- Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center, 6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA
| | - Terran Gregory
- Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center, 6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA
| | - Mary Walsh
- Health Care Sciences, Prosthetics-Orthotics Program, University of Texas Southwestern Medical Center, 6011 Harry Hines Blvd, Dallas, TX 75390-9091, USA
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Kunz F, Schweitzer T, Große S, Waßmuth N, Stellzig-Eisenhauer A, Böhm H, Meyer-Marcotty P, Linz C. Head orthosis therapy in positional plagiocephaly: longitudinal 3D-investigation of long-term outcomes, compared with untreated infants and with a control group. Eur J Orthod 2019; 41:29-37. [PMID: 29617743 DOI: 10.1093/ejo/cjy012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background As there are very few long-term studies on the effects of head orthosis on deformational plagiocephaly (DP), we investigated the outcomes of patients, including facial symmetry and dental occlusion. Methods Forty-five infants with DP [cranial vault asymmetry index (CVAI) > 3.5 per cent] were divided into two groups: one treated with head orthosis (32 infants) and another without (13 infants). Another group without head asymmetry (CVAI ≤ 3.5 per cent) served as control. Using 3D-stereophotogrammetry, cranial asymmetry was analysed using symmetry-related variables [CVAI, posterior cranial asymmetry index (PCAI), and ear offset]. Data acquisition was performed before (T1) and at the end of treatment (T2), and at the age of 4 years (T3) for the treated group and at T1 and T3 for the remaining groups. Parameters of facial symmetry and dental occlusion were assessed at T3 for infants with DP. Results Symmetry-related variables (∆T1-T3) improved significantly more in the treated than the control group, whereas these parameters did not differ significantly between the untreated and control group. Comparing the treated and untreated groups between T1 and T3, the reduction in the asymmetry at the treated group was significantly higher for the CVAI and PCAI. In follow-up, the untreated group showed higher incidences of facial asymmetries than the treated group. Seventy-five per cent of all lateral crossbites found in patients with DP were contralateral to the posterior flattening. Limitations Due to ethical reasons, the investigation is a non-randomized study. Parameters of facial symmetry were only assed for the treated and untreated groups. Conclusion Head orthosis therapy in patients with DP leads to significantly better long-term outcomes. Facial asymmetries are more frequent in patients with DP who do not receive this treatment.
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Affiliation(s)
- Felix Kunz
- Department of Orthodontics, University Hospital Würzburg, Germany
| | | | - Stephan Große
- Department of Orthodontics, University Hospital Würzburg, Germany
| | - Nina Waßmuth
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Germany
| | | | - Hartmut Böhm
- Department of Oral and Maxillofacial Surgery, University Hospital Würzburg, Germany
| | | | - Christian Linz
- Department of Orthodontics, University Hospital Göttingen, Germany
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Kelly KM, Joganic EF, Beals SP, Riggs JA, McGuire MK, Littlefield TR. Helmet Treatment of Infants With Deformational Brachycephaly. Glob Pediatr Health 2018; 5:2333794X18805618. [PMID: 30349871 PMCID: PMC6194925 DOI: 10.1177/2333794x18805618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/09/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022] Open
Abstract
Deformation of the cranium in infancy represents a spectrum of deformity, ranging from severe asymmetric yet proportional distortion of the skull in plagiocephaly, to nearly symmetric yet disproportional distortion in brachycephaly. As such, the condition is best described as deformational plagiocephaly-brachycephaly with isolated plagiocephaly and/or isolated brachycephaly being at either ends of the spectrum. Due to its symmetric appearance, deformational brachycephaly is often incorrectly dismissed as being less concerning, and it has sometimes erroneously been reported that brachycephaly cannot be treated successfully with a cranial orthosis. We prospectively report on 4205 infants with isolated deformational brachycephaly treated with a cranial orthosis from 2013 to 2017. These results demonstrate that the orthosis is successful in the treatment of deformational brachycephaly with an 81.4% improvement toward normal (95.0 to 89.4) in cephalic index. We furthermore demonstrate that entrance age influences treatment results, with younger infants demonstrating both improved outcomes and shorter treatment times.
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